The policy-practice nexus of electronic health records adoption in the UK NHS: An institutional analysis

This paper reports the findings from a seven-year study on the UK National Health Service on the introduction of an electronic health record for 50 million citizens. Using a longitudinal research method, data is collected on the policy-practice nexus. We apply institutional theory using a conceptual model by Tolbert and Zucker on the component processes of institutionalization. Our findings suggest that institutional forces act as a driver and an inhibitor to introducing enabling technologies in the health-care environment. A process analysis shows that as electronic health records force disruptive change on clinicians, healthcare managers and patients, culturally embedded norms, values and behavioural patterns serve to impede the implementation process. This research contributes to the theoretical literature on institutionalizm by addressing the dichotomy between institutional and technical environments. We suggest that while technology is often discussed in isolation of an institutional process, it either becomes embedded in organisational practices reaching a process of sedimentation (institutionalization) or fails to take hold and fades from view.